Abstract
OBJECTIVES: To develop a nomogram based on low-dose one-stop dual-energy and perfusion computed tomography (LD-DE&PCT) for predicting the efficacy of transcatheter arterial chemoembolization (TACE) combined with lenvatinib and immune checkpoint inhibitors (TACE-LEN-ICIs) in unresectable hepatocellular carcinoma (uHCC) patients. MATERIALS AND METHODS: This prospective, multicenter study included uHCC patients who underwent LD-DE&PCT scanning. The relationships between quantitative LD-DE&PCT-derived parameters and the efficacy of TACE-LEN-ICIs were analyzed using logistic regression analysis. A nomogram incorporating the independent predictors was constructed, and its predictive performance was evaluated by the area under the receiver operating characteristic curve (AUROC). RESULTS: A total of 125 lesions from 71 uHCC patients were enrolled, with 71 lesions (56.8%) classified as the objective response (ObR) group and 54 lesions (43.2%) as the non-response (NR) group. Univariate analysis revealed significant differences in tumor size, corona enhancement, tumor location, iodine concentration in the arterial phase (IC-AP), normalized iodine concentration in the arterial phase (NIC-AP), effective atomic number in the arterial phase (Z(eff)-AP), slope of spectral HU curve in the arterial phase (λ(HU)-AP), and permeability surface area product (PS) between ObR and NR groups. Among these, NIC-AP exhibited the highest predictive value (AUROC = 0.770; 95% confidence interval [CI]: 0.682‒0.858). Multivariate analysis identified tumor size, NIC-AP, and PS as independent predictors. The nomogram showed excellent performance (AUROC = 0.913; 95% CI: 0.858-0.968). The total radiation dose was 19.02 ± 5.39 mSv. CONCLUSION: The LD-DE&PCT-based nomogram can accurately predict the response to TACE-LEN-ICIs in uHCC patients. RELEVANCE STATEMENT: Low-dose one-stop dual-energy and perfusion CT provides a noninvasive method to predict response to TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC. KEY POINTS: Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making. NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers. NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC.